Beyond the strong recommendation for bisphosponates as initial medical therapy in postmenopausal women with osteoporosis, the updated guidelines also suggest (not recommend) denosumab as second line therapy in women, bisphosphonates for osteoporosis in men, and romosozumab in women with very high risk of fractures. For the complete updated guideline, see Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians.